Getting To The Root Of Headaches & Migraines

Headaches and migraines can be debilitating and are very common symptoms of the women I work with. I used to experience hormonal headaches during ovulation and right before my period for many years, especially when I had the copper IUD and was struggling with estrogen dominance. There are a number of different root causes of headaches and migraines, many of which we will cover in this newsletter. The reason it’s helpful to identify your root cause(s) is that that will help you identify how to address them in the first place. Let’s go through the most common causes of headaches and migraines:

  • Hormonal shifts/imbalances
  • Stress
  • Lack of sleep
  • Low blood sugar/skipping meals
  • Dehydration
  • Hypothyroidism
  • Mineral imbalances
  • Histamine intolerance (often related to gut health or mold)
  • Oral contraceptives
  • Changes in barometric pressure

Many of these are self-explanatory, so I’m not going to get in-depth on each one, but I will cover the hormonal shifts, stress, hypothyroidism, histamines, and minerals in detail.

Hormonal Shifts & Imbalances

Headaches and migraines that appear around ovulation or right before/during/after your period are typically related to hormonal shifts in estrogen. Estrogen controls certain chemicals in the brain that impact the sensation of pain. For example, an increase in estrogen is associated with an increase in serotonin, which can lead to more pain. Both a drop or rise in estrogen can trigger headaches and migraines. This is why it’s common to experience them around ovulation since we have an increase in estrogen leading up to ovulation, which then turns into a drop in estrogen. We get another increase in estrogen during the luteal phase, then a drop in both estrogen and progesterone right before menstruation begins. Estrogen levels then start to rise at the end of menstruation, which can also trigger both headaches and migraines.

When you understand that shifts in estrogen can lead to headaches and migraines, it’s easy to see why oral contraceptives can also contribute. Birth control pills with synthetic estrogen, progestin, and progestin-only pills can all cause headaches or migraines. Typically, the progestin only pills contribute less, but it really depends on the person.

How To Reduce Hormonal Headaches & Migraines

Since shifts in estrogen are a major culprit of hormonal headaches and migraines, supporting healthy estrogen and progesterone levels is the area we’d want to focus on. Clearly, there’s a lot to this. It’s everything I talk about all the time in relation to nutrition, minerals, thyroid, and gut health. Our hormones are the last thing to change, the final stop on the train.

From a high-level view, we’d want to support the following:

  • Thyroid Function: We need a healthy thyroid and enough active thyroid hormone in order to have strong ovulation and healthy progesterone levels. This also supports optimal digestion and gut health, which helps avoid estrogen excess.
  • Digestion & Gut Health: In order to avoid disruptions in gut bacteria and immune system function, we need adequate digestive juices (this is why the thyroid is so important for gut health). We also have what is called the estrobolome, which is a collection of gut bacteria that are capable of controlling estrogen metabolism and can impact our circulating levels of estrogen. They make an enzyme called beta-glucuronidase, which is important for breaking down complex carbs, reabsorbing micronutrients, and reabsorbing estrogen. It can convert estrogen from inactive to active forms.
  • Bile & Liver Detoxification: Most of our estrogen is metabolized in the liver, which ensures it finds its way into bile, which is then excreted into the gut to help us breakdown and absorb fats properly. The estrogen from the bile also comes into contact with the estrobolome.
  • Stress: As cortisol increases, estrogen also increases, and over time, progesterone gets depleted leading to further imbalance in estrogen and progesterone.
  • Minerals: Imbalances in minerals like copper, iron, calcium, potassium, and magnesium can all contribute to excess estrogen.

How do we do this? Here are five nutrition strategies for supporting these areas:

  1. Eating enough. I know I saw this all the time, but your body will be stressed if you don’t eat enough. Eating enough throughout the day and not skipping meals is a great way to support healthy blood sugar and thyroid levels. We need to eat regularly to keep active thyroid hormone levels in a good place.
  2. Balancing your meals with protein, fat, and carb.
  3. Including digestion-supportive foods early in your meal like bitter foods like arugula, raw carrots, or ginger (can also do ginger tea if you want).
  4. Including fiber-rich foods. Fiber helps bind to bile and remove from the body through stool–this helps eliminate toxic bile and reduces toxic burden on the body. Fiber in general is supportive of beneficial bacteria in the gut to keep a stable and healthy microbiome. My top foods to include are beans, raw carrots, oats, cooked greens, plantains, potatoes (especially cooked and cooled for the resistant starch). I have seen a pretty significant difference in clients when they get more intentional with fiber (as tolerated).
  5. Including liver-supportive foods like dandelion greens, artichokes, and beets.

What about alternatives that someone can use to pain meds when they get a hormonal headache or migraine? One of my secret weapons for hormonal headaches and migraines is vitamin E! How does this vitamin help hormonal headaches and migraines? This research article  looks at vitamin E (as well as other vitamins) as prophylactic treatment for migraines and menstrual migraines. The researchers found that menstrual migraines are often related to prostaglandins (inflammatory proteins) and since vitamin E is anti-prostaglandins, it is effective. They found that “with the use of vitamin E therapy (400 IU/daily for five days during menstruation for 3 cycles), there have been no reported breakthrough headaches.” That’s pretty amazing. Even taking 400IU of vitamin E daily was helpful. I have also seen clients take an additional 1-2 capsules of vitamin E (400 IU) right when they feel a headache or migraine coming that they think is hormonal and it helps it go away. Please make sure you talk with your doctor and consider any other supplements or medications you may be taking before trying this.

Stress, Blood Sugar, & Headaches and Migraines

Headaches and migraines are a stressor and interestingly enough the stress of them can contribute to their chronic nature for those that struggle consistently longterm. There are a few major ways that stress can trigger a headache or migraine:

  1. Physical tension. This is known as a tension headache or migraine. For many, it’s their traps and upper back muscle that are tight, which then tightens their neck and then can lead to a tension headache or migraine. Migraines specifically have a few other trigger areas by muscles in the head like between the brow muscles. This is where the supraorbital nerve branches weave together and has been shown to trigger migraines when tension builds. The back of the head where the occipital nerve gets pressured by tight neck muscles is another common one. The tightness and tension in these muscles and the impact it has on the nerves is why botox can be effective for some that have migraines since they can put it right in these areas. I am not recommending botox for migraines, but I often get the question of why it works, this is how. It’s reducing the tension–it doesn’t let the muscle tighten up because it blocks it from receiving certain chemical messengers from our nerves.
  2. Stress hormones. Stress hormones can increase tension, so they are definitely a contributor to the physical aspect of headaches and migraines, but they also impact many other areas of our health. For example, stress hormones often cause an increase in estrogen and a decrease in available thyroid hormone in the body, both of which can contribute to migraines. We also use up many important minerals like magnesium during the stress response and magnesium deficiency  is one of the many different contributors to migraines. I’ve seen some research on the connection between a hormone called CRH, that is released during the stress response, but not enough to be conclusive. It can lead to more inflammatory proteins being released from the immune system, so who know, maybe one day we will see a connection.

We are always going to experience stress, so I’m not going to say that those that suffer with headaches and migraines need to get rid of all of their stressors. That will likely just cause more stress, but I do think it’s helpful to know that you may be more sensitive to it. Even paying attention to what makes your body feel more stressed, when that happens, and if there’s anything supportive you can do in the meantime is a great place to start getting curious. What helps someone reduce stress may not help another person. I think it’s important to mention that nourishing your body and hydrating can help make you more resilient to stress. So instead of feeling like you need to add more things to your list, if you aren’t doing those consistently, just focus on that.

What about more natural prophylactic remedies for stress related headaches and migraines? Magnesium is often a very helpful one. This study  found 500mg of magnesium oxide was just as helpful as valproate sodium at reducing migraines.

Another aspect of stress and why I think those that get frequent migraine headaches are more sensitive to stress is the fact that those that suffer with chronic migraines  have been shown  to excrete 50% more sodium in their urine (meaning they lose 50% more sodium) than people that do not suffer from migraines. We also use up sodium during the stress response and I find that many people are depleted when we look at their hair tissue mineral analysis (HTMA). There has been research done on the amount of cortisol released by those that suffer with migraine headaches, but there was no difference in those that did not and the amount released. I hope they look further into this with minerals in the future since I think that is the major difference.

A final aspect of stress that if you’ve been reading my newsletter for a while you were probably waiting for is blood sugar. Having big swings in our blood sugar can be stressful. It can also impact sodium loss. We can see this in a study from 2015  where they looked at sugar, sodium, and migraine frequency. They found that a reduction in sugar, optimizing the sodium to potassium ratio, and an increase in water consumption significantly reduce migraine days, even for those that were using Topomax.

For sodium:

“We found the ideal sodium dose for migraine prevention to be 30% to 50% greater than the USDA 2400 mg maximum Na+. This group benefited most when they increased their sodium intake by 70% relative to the USDA recommended maximum.”

I think it’s important to mention they did not remove all carbs, but all sweeteners (both natural and artificial). They even tested the theory after to see how participants would react to sugar.

“In order to more fully evaluate the role of sugar in migraine onset and sodium in migraine cessation, we encouraged each recovering migraineur to enjoy a sugary candy or dessert after they were fully migraine free. This caused a migraine in every single participant without exception. The administration of a 1/8th teaspoon salt after consuming the sweets with only a sip of water stopped the migraine within 10 minutes.”

Now this sounds pretty amazing, but we don’t know if they advised them to have the candy on an empty stomach or not. My guess is it was an empty stomach and because of the big blood sugar swing and sodium loss it caused, the migraine came on. I would have loved to see the different of adding the dessert in right after a balanced meal. Since that creates less of a swing, I would imagine they would have been fine. I don’t think everything that struggles with migraine headaches needs to avoid all sugar, but I would focus on eating protein foods first and having a little sea salt with sugary desserts help offset magnesium loss. I thought this was a powerful example of how important blood sugar balance is for migraine and headache management.

Hypothyroidism & Headaches and Migraines

Research  has indicated that hypothyroidism should be considered a comorbidity for those that suffer with migraine headaches. Migraines are much more frequent and likely for those that have hypothyroidism. We unfortunately still do not know that exact mechanism of the suspected bidirectional relationship between the two. Many studies  have shown that the two often coexist together and that many people with low thyroid hormone levels also suffer from migraine headaches. Another review  on chronic tension-type headache found coexistence of migraine and hypoactivity of the hypothalamus-pituitary-thyroid axis. This goes back to the stress response piece since our adrenals are involved in this as well. We don’t have data to show the actual mechanism, but if we think about how stress works and how it impacts thyroid hormone levels, we know that cortisol (stress hormone) blunts TSH and leads to lower levels of T4 and T3 (see image below). We also know that stress contributes to those with migraine headaches (see section above).

Hypothyroidism leads to less of an uptake of sodium and potassium. Remember how sodium was excreted at a level of 50% more in the urine of those that suffer with migraine headaches? If we pair that with the lower levels that are taken up with those with hypothyroidism, that is a recipe for disaster. Not to mention that our thyroid impacts our digestion, blood sugar balance, and our ability to produce adequate levels of hormones. I have an entire free training that goes through how to assess your thyroid health and nutrition to support it here.  It’s way more than I could ever cover in this already very long newsletter. 

Histamines & Headaches and Migraines

Have you ever heard that certain foods can set off a headache or migraine? This is often related to a histamine response that someone is having in relation to eating that food. This shows that the concept of histamines being related to migraine headaches is not new. What are histamines, you ask? Histamines are proteins that are in every tissue of the body. They are made by mast cells, basophils, platelets, some neurons, and other cells and are most commonly known for their role in our immune system and responding to immune threats in the body. Histamines also communicate with the brain and support the release of stomach acid, which is essential for optimal digestion.

We clearly need histamine, but when we have too much it causes problems. We fill up our histamine bucket and it starts to overflow, which is when we begin to get symptoms. Figuring out if your symptoms are from too many histamines can be tricky since your symptoms can change day to day. One day you may have a headache or migraine and the next you could have heart palpitations and itchiness. How is it that histamines can impact so many different areas of the body? They have receptors that they can attach to in many different tissues. For migraines, histamines bind to H3 receptors  in our central nervous system, which can lead to vertigo, headache, nausea, vomiting, insomnia, panic, anxiety, and depression.

There are many root causes of histamine intolerance , I did a whole podcast episode on this that is linked below in this week’s podcast of the week. Below is a very very brief summary of the root causes. Please listen to the full episode for more on this! I want to focus specifically on the research on migraine headache sufferers and histamines in this newsletter, so I’m keeping this portion short.

Root Causes of Histamine Intolerance

  • Nutrient Deficiencies (Copper, Vitamin A, Vitamin C, Vitamin B6, Iodine)

  • Poor Gut Health/Imbalances In Microbiome
    • Certain bacteria cause mast cells to release histamine while other bacteria can actually produce histamine.
    • Morganella species and Klebsiella species can both lead to a lot more histamine production and lead to histamine intolerance symptoms.
    • H. pylori (pathogenic bacteria in the stomach) can cause mast cells to degranulate, which leads to histamine being released into your system.
    • Parasites can increase IgE levels leading to a heightened immune response.
    • Low immune system function
  • Excess estrogen (estrogen stimulates histamine release and slows down the DAO enzyme, histamines then lead to more estrogen release in the ovaries)

  • Certain medications can block the DAO enzyme that is responsible for breaking down histamines
    • Painkillers (including aspirin)
    • Antihistamines (tylenol, advil, benadryl, tagamet, etc.)
    • Anti-arrhythmics
    • Anti-asthmatics with theophylline
    • Antidepressants with amitriptyline
    • Blood pressure medications
    • Diuretics like Lasix
    • Certain antibiotics
    • Immune modulators like Humira
    • Birth control doesn’t block the DAO enzyme, but the types that contain synthetic estrogens can increase histamines

If we look at those that specifically struggle with migraine headaches and what the research tells us in relation to histamine intolerance, we can see a clear connection. One of the most interesting concepts being that  87% of migraine  patients have a deficiency in Diamine Oxidase (DAO), which is the enzyme responsible for histamine breakdown and that this did lead to an increase in migraines. This makes sense since  research  has also shown that supplementing with a DAO enzyme has helped to reduce migraines. We need more research with larger sample sizes on this, but I think it’s telling. The other interesting concept in relation to histamines and migraines is the fact that  research  has shown people with chronic migraines have higher levels of histamine in their plasma and increased histamine-releasing brain mast cells.

How To Reduce Migraines If Histamines Are A Concern

If you think histamine intolerance could be at least part of your root cause for migraine headaches, there are a few things I would consider for reducing symptoms:

  1. Consider supplementing with a DAO enzyme. Talk with your doctor, share the research, and see if this is a good fit for you. There aren’t any downsides to it other than it might not improve your symptoms. If you’re one of the 87% of people with migraines that have a DAO enzyme deficiency, it could be a huge help.

  2. Look into other possible root causes for histamine intolerance:
    1. Do you have a history of gut/digestive issues? Stool testing would be a great next step.
    2. Do you also have hormonal symptoms like PMS, period pain, or headaches/migraines around ovulation/your period? Consider testing your hormones to see if estrogen dominance is part of your histamine issues (since it drives up histamine). If estrogen is part of it, I would really encourage you to do hair mineral testing in order to figure out what’s causing the high estrogen. Hormone testing tells you if hormones are high or low but not why.
    3. Do you have nutrient deficiencies? We need copper, vitamin C, vitamin B6, and vitamin Ain order for the DAO enzyme to work properly.

Keep in mind it can be more than one root cause. I talk about these all in more detail in my podcast episode on histamine intolerance .

Minerals & Headaches and Migraines

I’ve already mentioned minerals quite a few times when it comes to headaches and migraines, but we have to go even more in depth! A quick recap of the minerals we already covered:

  1. Magnesium: magnesium deficiency is a known contributor to migraines (we discussed this in relation to stress since we deplete magnesium during stress)
  2. Sodium: migraine sufferers excrete 50% more sodium in their urine (meaning they lose 50% more sodium) than people that do not suffer from migraines (we again discussed this in relation to stress since we use sodium during the stress response)

Now we have to consider the minerals and vitamins that actually fuel the DAO enzyme. Bioavailable copper (when copper is activated by vitamin A and turns into Ceruloplasmin) is what activates the DAO enzyme. That means that if we have low copper or vitamin A levels and cannot produce enough Ceruloplasmin, we won’t be able to activate the DAO enzyme properly. This can lead to a build up of histamines and then cause a headache or migraine.

We also need vitamin C and vitamin B6 in order for the DAO enzyme to function properly. Vitamin C also happens to be a powerful antioxidant that protects the body from stress and inflammation and is used up during the stress response to support our adrenals. Once again, stress is having a huge impact on all aspects of health. One thing that comes to mind when I think about vitamin C deficiency and how this impacts histamines is mold and gut issues. Mold exposure increases oxidative stress in the body, which uses up more of our powerful antioxidants like vitamin C. Many people with symptoms from mold exposure struggle with histamine intolerance and can see improvements with more vitamin C.

We couldn’t talk about minerals and histamine without mentioning iodine! Iodine helps to decrease histamine production. Iodine inhibits the conversion of histidine (an amino acid) to histamine. When iodine levels are sufficient, it helps to keep histamine in check. When we become deficient, we can see an excess of histamine. We also need adequate iodine in order to make enough thyroid hormone for a healthy metabolism and healthy hormones. Excess estrogen can contribute to histamine build up as well (we discussed this during the hormonal portion last week).

Check out foods to prioritize for these nutrients below!

As you can see, there are many possible contributors to headaches and migraines. We have covered A LOT in the last two newsletters, but I hope this helps those that are struggling. Remember, it’s not about addressing everything at once, but chipping away slowly and seeing what helps you feel better. It’s tempting to want to do a million lab tests and start taking all the supplements, but that often creates more chaos. I think the best thing we can do when dealing with any health concern is starting to get curious and paying attention more. Making note when we have symptoms and trying to look for patterns. That can all bring you closer to what will make the most significant change for you. 

reminder: i’m currently taking on 1:1 clients. if you’d like to explore what it would be like to work together and if we are a good fit, fill out this form to get more details!​

Amanda Montalvo

Amanda Montalvo is a women's health dietitian who helps women find the root cause of hormone imbalances and regain healthy menstrual cycles.

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